Clinical Outcomes of Endoscopic Removal in Patients with Colorectal Polypoid Leiomyomas

Abstract

Background/Aims: Although polypoid leiomyomas in the colon and rectum are rare, they are increasingly detected during colonoscopy. The aim of this study was to evaluate the efficacy and clinical outcomes of endoscopic removal for colorectal polypoid leiomyoma. Methods: Data were retrospectively collected from 22 patients with polypoid leiomyoma arising from the muscularis mucosae in the colon and rectum who underwent endoscopic removal at single referral gastrointestinal endoscopy unit. Colonoscopic findings, endoscopic removal, success rates, complication rates (bleeding or perforation), pathologic characteristics, and recurrence rates were investigated. Results: Most polypoid leiomyomas were small asymptomatic lesions less than 1 cm. The tumors were located predominantly in the left colon. Ten leiomyomas were removed using cold biopsy forceps, and 12 were resected by conventional polypectomy or endoscopic mucosal resection. All tumors arose from or involved the muscularis mucosa. There were no complications, such as bleeding or perforation. No local remnant lesions were found in 19 patients who underwent at least one follow-up colonoscopy. Conclusions: This case series represent cases of small colorectal polypoid leiomyoma that were safely removed endoscopically. An awareness of their endoscopic and clinic-pathological characteristics may provide safe treatment strategy for colonic leiomyomatous tumors of similar size in capable hands. (Korean J Gastroenterol 2016;68:179-185)

Sigmoid Leiomyoma: An Uncommon Occurrence

“…Hence, tumor size, site, histological appearance, and mitotic count should be considered to predict the malignant potential of these colonic smooth muscle tumors [1]. Most colonic leiomyomas with absent histologic testing are often misdiagnosed as epithelial polyps because they present as solitary sessile intramural or intraluminal polyps [6,7].…”

“…Endoscopic removal of colonic leiomyomas is considered an appropriate treatment modality because most of them arise from the muscularis mucosa [7,8]. Several endoscopic techniques, including removal of leiomyomas using cold forceps biopsy, conventional polypectomy, or endoscopic mucosal resection, have been successful without causing bleeding or perforation [7]. Endoscopic snare polypectomy has been successful in completely removing the tumor in most cases [3,8].…”

“…A positive lift sign would indicate the tumor is superficial enough to be completely resected endoscopically. However, a negative lift sign indicates the tumor is deeper, seated in the muscle itself, and should contraindicate endoscopic removal [7]. Endoscopic mucosal resection often ensures the entire tumor is removed.…”

Two Cases of Leiomyoma in the Colon Masquerading as Other Types of Colonic Pedunculated Polyps

“…Although colonic leiomyomas predominantly appear as sessile lesions, they can form semipedunculated or pedunculated lesions as well [ 6 ]. Choi et al reported 22 cases with leiomyomas arising from the muscularis mucosae in the colon [ 7 ]. Seventeen cases showed sessile polyps, while the remaining five cases showed pedunculated morphology.…”

“…Several authors have noted that most colonic leiomyomas with sessile morphology mimic epithelial polyps in their gross appearance during colonoscopy [ 4 , 7 ]. Choi et al reported that 45.5% of colorectal leiomyomas (10 of 22 lesions) were accurately diagnosed based on their endoscopic features [ 7 ]. However, more than half of colorectal leiomyomas were not correctly diagnosed prior to undergoing resection.…”